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. 2012 Apr 10:20:28.
doi: 10.1186/1757-7241-20-28.

Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study

Charlotte Barfod  1 , Marlene Mauson Pankoke Lauritzen, Jakob Klim Danker, György Sölétormos, Jakob Lundager Forberg, Peter Anthony Berlac, Freddy Lippert, Lars Hyldborg Lundstrøm, Kristian Antonsen, Kai Henrik Wiborg Lange
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Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study

Charlotte Barfod et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures.

Methods: The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, T(vitals), and presenting complaint, T(complaint). The more urgent of the two determines the final triage category, T(final). We retrieved 6279 unique adult patients admitted through the Emergency Department (ED) from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures.

Results: The covariates, T(vitals), T(complaint) and T(final) were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO(2)), respiratory rate (RR), systolic blood pressure (BP) and Glasgow Coma Score (GCS). Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5%) and 'altered level of consciousness' (10.6%). More than half of the patients had a T(complaint) more urgent than T(vitals), the opposite was true in just 6% of the patients.

Conclusion: The HAPT system is valid in terms of predicting in-hospital mortality and ICU admission in the adult acute population. Abnormal vital signs are strongly associated with adverse outcome, while including the presenting complaint in the triage model may result in over-triage.

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Figures

Figure 1
Figure 1
Selection of the study cohort. Patient records were excluded as explained in the figure. The final cohort included 6279 patients, representing the latest admission for every patient having a primary triage performed in the study period.
Figure 2
Figure 2
Vital signs defining the colour-coded triage, Tvitals. RR: respiratory rate; SpO2: saturation of peripheral oxygen (pulse oxymetry); HR: heart rate; GCS: Glasgow Coma Score; Tp: temperature; ICU: Intensive Care Unit.
Figure 3
Figure 3
Presenting complaint algorithm; chest pain. ECG: Electrocardiography; VAS: Visual Analog Scale. Definitions of the terms used in the figure, e.g. 'ECG changes', 'chest pain of cardiac origin','functional dyspnoea' and 'risk patients' are found in the triage manual [7].
See this image and copyright information in PMC

References

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